Oana-Maria Cozma

SDI, 1st year

Is it worth? Médecins Sans Frontières in Syria

Abstract: This paper intends to track the activity of a relevant nongovernmental actor in
the international system- Médecins Sans Frontières (MSF) - in one of the most well-known event
which hunts the global arena since 2011- the Syria conflict. In the beginning, it is important to
drawn a conceptual framework of the nongovernmental organizations (NGOs), in order to see what
MSF represents as a global actor. It is also important to stress what is happening in Syria, in the
direction of observing how and why the conflict evolved as time passed. The article proposes to
emphasize how MSF reacted towards Syria conflict, and if its reaction was efficient or not.
Furthermore, this paper attempts to see which causes determined the efficiency or the inefficiency
of MSF’s activities in this conflict. In the end, this paper will try to indicate certain
recommendations of how MSF could improve its reaction and activity in the Syria conflict.

Key words: NGOs, MSF, Syria conflict, international system, activity, reaction

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Introduction

Nongovernmental organizations- as they are

In terms of conceptual framework, it is true the fact that NGOs do not have generally
accepted definition among the international relations specialists. The NGOs historic starts with
1945 year when the 71st Article allowed the Economic and Social Council of UN to establish
appropriate arrangements in order to consult them.1 Over the last century, volunteer and
nongovernmental organizations took over the contemporary society’s social challenges- in fields
like peace, environment, human rights, or women rights. With a general commitment for the
poverty’s reduction, these international agencies, which involved assistance, managed to draw the
attention on issues too important to be were ignored. Stimulated by social disorders, the increased
attention on the inequality of human existence, lead to a fast expansion both in number and in
importance of NGOs.2
NGOs are voluntary associations which do not participate in the struggle for political power
sharing, nor have a mandate from the government or state for their existence and activities. These
entities raise and militate not for their own interests, but for the others interests who are
symbolically represented as innocent, oppressed, neglected, unrepresented, dispossessed and
despised, excluded, disadvantaged and forgotten. This activity for “the others” is really tight by
the systematically cultivation of alliances across international borders and it is broadly inspired by
universal ideals.3 It is also important to mention here a less bright side of the NGOs- for example,
there are critics who claim that in the whole world there are a lot of injustice and suffering, but
only few of these issues get the NGO’s attention.4 Why? Maybe because NGOs do not usually
focus on representing the disadvantaged’s interests, but to defend their own organizational
interests.5 This is only one negative aspect of these entities, however, even though NGO’s face a
lot of more critics, it is not the intention of this paper to analyze them.

1
Anton Carpinschi and Diana Mărgărit, International organizations, Polirom, Iași, 2011, p. 9
2
Sherri Roff, ”Nongovernmental organizations.The strengths perspective at work”, International Social Work, vol.
47, no. 2, 2004, p. 205
3
Volker Heins, Nongovernmental Organizations in International Society. Struggles over Recognition, Palgrave
Macmillan, Fifth Avenue, NY, 2008, p. 19
4
Volker Heins, op. cit., p. 142
5
Liesbet Heyse, Choosing the lesser evil, understanding decision making in humanitarian aid NGOs, Ashgate,
Aldershot, 2006, p. 21

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Médecins Sans Frontières and its mission

MSF was official created for the first time on the 22nd of December 1971. Back then, it had
300 volunteers who basically composed the organization: doctors, nurses, and other members of
the staff, together with thirty journalists. MSF was created on the belief that all human beings have
a medical right no matter what gender, race, religion or political affiliation they have, and that the
needs of these suffering people go above the national borders.6 MSF first mission was in the capital
of Nicaragua country, Managua, where in 1972 an earthquake destroyed almost the entire city and
killed somewhere between 10,000 and 30,000 people. In 1974, MSF initiated a mission in order to
help the citizens of Honduras after what the Fiji Hurricane caused major flood and provoked
numerous victims. Then, in 1975, MSF established the first medical program at a worldwide scale,
in the context of a refugees crises determined by the repressive regime of Pol Pot in Cambodia-
MSF provided medical aid to numerous waves of Cambodians who were trying to escape from an
extremely abusive dictator.7

What is happening in Syria?

Beginning with the beginning, between December 2010 and March 2011 a Tunisian protest
against a dictator spread to Egypt and then to Libya, Yemen, Bahrain, and Syria and also in several
other countries, but a lowers intensity.8 It is clear that there are many different military factions
which support and fight for different interests. The main actors in this conflict are The Bashar Al-
Assad forces, supported by different countries as Iran or Russia, the Free Syrian Army, supported
by allies as U.S. or Saudi Arabia, the Kurd Forces YPG and YPJ. Besides these three combatants’
parties, there are also two main radical jihadi groups which represent the Islamic extremism. Jabhat
Al-Nursa is one of them, and it fights against the Syrian government in order to establish its own
Islamic state on the Syria territory. The Islamic state of Iraq and Syria (ISIS) is the other one, and
it is the most well-known terrorist group, having a great visibility all over the world. These two
extremist groups fight one against each other, even though, both of them have the same aim-

6
Doctors without borders, ”Founding MSF”, 2016, http://www.doctorswithoutborders.org/founding-MSF, accesed
on 11/18/2016
7
Ibidem
8
Marc Lynch, Deen Freelon and Sean Aday, ”Syria in the Arab Spring: The integration of Syria’s conflict with the Arab
uprisings, 2011–2013”, Research and Politics, DOI: 10.1177/2053168014549091, 2014, p. 1

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establishing an Islamic state.9 Gradually, more and more external actors, as U.S. or Russia, have
intervened in this conflict directly, or indirectly by supporting different factions. From what we
can see, the situation in Syria is really complex and difficult, and at the same time, without a
common and an efficient political solution, the international community failed.

Content

How MSF reacted to the Syrian conflict?

As any other international NGO which promotes the medical right, MSF tried to
accomplish its general propose in Syria by trying to save the innocents lives through humanitarian,
and especially medical aid. In order to illustrate MSF’s activity in Syria, it is worth to present
several actions undertaken in region by this organization. Therefore, MSF managed to accomplish
102,828 medical consultations, 4,899 surgeries performed, 77,800 people vaccinated, 1,516
maternity deliveries, 77,800 children vaccinated against measles, and there are also 90 health
structures across Syria supported remotely with medical supplies.10 MSF continued to operate six
medical facilities in different locations across northern Syria and saw an increase in the number of
people with medical complications caused by delayed medical care, and in infections and deaths
due to shortages of antibiotics. MSF also increased its support program to around 70 healthcare
facilities run by Syrian doctors. MSF provides technical advice, medical supplies, salaries and fuel,
and helps rebuild damaged buildings. MSF also gives ad hoc support such as medical donations to
around 80 other medical facilities in emergency situations, for example massive influxes of
casualties. No MSF staff are present in these supported facilities.11 MSF also addressed a letter to
the Member States of the High Level Group in Syria12. The President of MSF International, Dr.
Joanne Liu, claimed the fact that the work of international NGOs shows that it is possible to engage
with opposition groups, even the most radical, in order to directly help sick, wounded and

9
Lucy Rodgers, ”Syria: The story of the conflict”, BBC News, 11 March, 2016, http://www.bbc.com/news/world-
middle-east-26116868, accessed on 11/18/2016
10
MSF, ”Syria Emergency Appeal”, http://www.msf-me.org/syria/, accessed on 11/18/2016
11
MSF, ” Millions of people are in desperate need of lifesaving humanitarian aid”,
https://www.msf.org.uk/country/syria, accessed on 18/11/2016
12
The High Level Group on Humanitarian Challenges in Syria (HLG) was created to foster and maximise cooperation
among those countries with influence over parties to the Syrian conflict.

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displaced. The greatest concern was that there is an urgent need to significantly increase cross-
border assistance and to prioritize this issue in negotiations on humanitarian aid.13

Is the MSF’s reaction efficient or inefficient in the Syrian conflict?

It is indeed difficult to say it loud and clear that MSF’s reaction in this conflict was efficient
or inefficient, due to the fact that its activities in Syria were, and continue to be even today, useful
and useless at the same time. There can be find arguments in favor of the efficiency and
inefficiency as well. Undoubtedly, MSF reaction in Syria was efficient because they managed to
save unheeded lives. Together with other NGOs, MSF succeeded in defending the innocent
civilian’s fundamental rights- as the right to live. By providing medical aid, MSF managed to
reduce suffering among wounded, to help desperate people in critical situations- for example
women who were about to lose their babies as a result of the impossibility to give birth in an
appropriate manner. It is wrong to see human beings’ lives only through numbers and statistics
because only one life saved represents enormously. This idea, which is at the same time a reality,
makes MSF’s actions efficient in Syria, and no one should be skeptical in regards to this fact
because we are talking about innocent lives lost in vain.
In order to be objective, and not to give to the ones who always criticize other reasons to
judge NGOs, it must be mentioned that MSF reaction in the Syrian conflict has its inefficient parts.
In spite of the entire effort expanded by MSF and other NGOs to deliver humanitarian aid in Syria,
there is still a large number of people who are dying, and a lot of areas where this humanitarian
aid never arrives. In particular, MSF manages to provide its medical aid in a limited numbers of
zones in Syria, and only a few number of wounded receive any help. There are still a lot of civilians
who die or get seriously injured due to the direct and non- discriminatory attacks over them. MSF
is inefficient because it has no power in expanding the areas where it can intervene to provide
medical aid. As we can see, MSF reaction is efficient and inefficient as well, because it fulfills its
aim as and a humanitarian NGO, but at the same time, the results are no that bright. In a much
more balanced position, I would claim that MSF’s reaction is efficient, positive, beneficial
however, it is just not enough.

13
Dr. Joanne Liu, ”Letter to the Member States of the High Level Group on Syria”, MSF, 18 December, 2013,
http://www.doctorswithoutborders.org/news-stories/speechopen-letter/letter-member-states-high-level-group-
syria, accessed on 11/18/2016

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Which are the causes of the MSF’s inefficient reaction in the Syrian conflict?

As argued before, even though we can catalogue MSF’s reaction in Syria as inefficient, we
always have to bear in mind its beneficial activities. I tend to believe that a cause which determines
the MSF’s efficiency in Syria is its main aim of providing medical right to those ones who are
especially in need- it produces a great mobilization among people who have the strong will to help.
MSF’s usefulness can be also caused by a high level of organization which coordinates all their
actions in the proper direction.

In order to be objective, it is more suitable for this paper to discuss about what causes
MSF’s inefficient reaction in Syria. Disregarding the mainstream causes brought into discussion
when we talk about the inefficiency of a NGO in general- NGOs worthlessness of being able to
determine the political will, or their hidden propose of acting in a certain way just to fulfill some
government’s interests- there could be observed exogenous causes which determine this
inefficiency. One specific respect which causes the inefficient reaction is the fact that MSF did not
receive authorization from the Syrian government in order to intervene on its territory. This
organization only directly engaged opposition groups, and so it managed to negotiate access to
areas they held in the north.14 We can observe that aid which could be provided by MSF only
arrives in a few conflict areas, therefore, there is a trace of inefficiency. Another cause can be
represented by a larger issue met in this kind of situations- the international humanitarian law’s
violation. The international humanitarian law is a set of rules which seeks, from humanitarian
reasons, to limit the effects of the military conflict. It aims to protect the civilians who are not
directly involved in hostilities, and it restricts the means and methods of violence. 15 This respect
is at the same time interconnected with another cause- the perpetual state of conflict. Having these
two causes in mind, we can easily notice that as long as the combatant parties will not pay attention
to what humanitarian law represents, somehow the activity carried by any humanitarian actor is at
a high percentage in vain. This is exactly what is happening in Syria right now, this is what is
happening with MSF. It is said that health represents a tool of repression, and the testimonials,

14
Joanne Liu, „Syria: Unacceptable humanitarian failure”, MSF, 11 March, 2015, http://www.MSF.org/article/syria-
unacceptable-humanitarian-failure, accessed on 11/20/2016
15
ICRC, „What is International Humanitarian Law?”, https://www.icrc.org/eng/assets/files/other/what_is_ihl.pdf,
accessed on 11/20/2016

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though not fully verified, provide a consistent pattern of abuse and repression by the regime within
the health system, including brutal torturing and persecution of doctors.16 There are many
examples that can support the idea according to which the violation of international humanitarian
law causes the inefficiency of MSF’s reaction in Syria. A very pregnant issue is the bombing of
hospitals- in east Aleppo, two hospitals supported by MSF and other organizations, have been
severely damaged in indiscriminate bombing of the city and have been forced to halt all activities-
attacks caused the death of patients and injured medical staff.17 Sometimes, it is almost impossible
to be efficient when all actions you want to take are hampered by violent external factors.

How could MSF improve its reaction?

It would be easy to address criticisms towards MSF activity in Syria, activity which seems
to be more inefficient than efficient. MSF could be criticized by the fact that it is just another weak
NGO which does nothing useful, and it appears in the landscape of the conflict only to be a
decoration of the whole framework. Taking into account the exogenous causes which determines
MSF’s inefficiency, it would be indeed difficult to make recommendations in this regard. Even
though it is improperly to call it recommendation, there could be one aspect which can brought
into question, but is related to the general activity of the NGOs. It refers to a greater effort from
the international community to make respected the international humanitarian law. It is true that
there have been continuously efforts towards the implementation, and the improvement of the
humanitarian law. In regards to this issue, there is a difficulty which is about those actors involved
in a conflict who do not recognize at all the humanitarian law. For example, extremist factions in
Syria, as ISIS, or even the governmental powers, completely ignore the humanitarian law or
intervene in order to destabilize it. However, what is more serious and sadder at the same time, is
the reality- there is a massive difference between the theoretically level and the practical one when
we talk about states and factions which adhere to the idea of respecting humanitarian law. The
issue subsists in the fact that governmental actors in their official discourse support the idea of
humanitarian law, but when a violent conflict arises, as the one in Syria, these actors ignore their

16
Stockholm International Peace Research Institute, ” The use of health as a tool of repression in Syria”, SIPRI, 26
March, 2012, https://www.sipri.org/commentary/blog/mon-03-26-2012-14-00/use-of-health-as-a-tool-of-
repression-syria, accessed on 11/20/2016
17
MSF, ” Syria: Two surgical hospitals bombed in east Aleppo”, MSF, 28 September, 2016,
http://www.msf.org/en/article/syria-two-surgical-hospitals-bombed-east-aleppo, accessed on 11/20/2016

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declarations and infringe what humanitarian means. Basically, this recommendation refers not to
MSF or other NGOs directly, but to the international community as a whole. All entities composing
the global arena should understand better the importance of the international humanitarian law in
order not to extinct communities, peoples and nations.

Conclusions
It is necessary to specify that this paper does not intend to take sides, and it is not a
eulogizing of NGOs in general, and of MSF in particular. We saw what NGOs represent as
international actors, which are their positive and negative parts as well, what MSF is and does, and
more important, we had an overview about the endless Syrian conflict. We were able to observe
how MSF reacted towards Syrian conflict- its involvement in this context supposes primarily
medical aid, and the support offered to the medical infrastructure. MSF is trying to provide a wide
range of medical and humanitarian aid to innocent people who are indeed in need. Its activity
focuses on helping civilians wounded by the indiscriminate attacks from combatant parties, and
civilians who suffer due to the lack of domestic medical support- even though there is a in conflict
zone, people still become ill, women still need to give birth to babies, and so on.
This paper stressed the fact that MSF’s reaction in Syria can be seen as efficient and
inefficient at the same time. On one hand, we can claim its reaction is efficient through the fact
that what MSF does saves lives, and it this incontestable efficient at any time. On the other hand,
MSF activity is inefficient because its help is provided to a few number of people in need as this
organization does not have authorization from the Syrian government in order to enter in country.
MSF reaction is weak again because the violation the humanitarian international law represents a
great impediment. It is sometimes in vain trying to provide medical aid as long as combatant parts
involved bomb places where you want to provide that help. In categorizing the features of MSF’s
reaction in Syria, we saw which causes its inefficiency. As mentioned before, this paper did not
propose to bring into question those mainstream internal causes- as the lack of power NGO usually
states- it aimed to emphasize the exogenous factors which weaken NGO’s activities.
It was difficult to find recommendations in order to improve MSF’s reactions in Syria as
most of the weak points are provoked by external factors. It is really important to raise the
awareness towards the respect of humanitarian law, because it represents the main impediment in
a continuous and efficient activity of these humanitarian actors in general. In order to answer to

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the question posed in the title, and going back to the degree of MSF’s efficiency in Syria, the main
point is that its activity over there is not necessarily worthless, but insufficient.

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References
Carpinschi, Anton and Mărgărit, Diana, International organizations, Polirom, Iași, 2011.

Doctors without borders,”Founding MSF”, 2016,

http://www.doctorswithoutborders.org/founding-MSF, accesed on 11/18/2016.

Heins, Volker, Nongovernmental Organizations in International Society. Struggles over

Recognition, Palgrave Macmillan, Fifth Avenue, NY, 2008.
ICRC, „What is International Humanitarian Law?”,
https://www.icrc.org/eng/assets/files/other/what_is_ihl.pdf, accessed on 11/20/2016.

Liesbet Heyse, Liesbet, Choosing the lesser evil, understanding decision making in humanitarian
aid NGOs, Ashgate, Aldershot, 2006.

Liu, Joanne, ”Letter to the Member States of the High Level Group on Syria”, MSF, 18
December, 2013, http://www.doctorswithoutborders.org/news-stories/speechopen-letter/letter-
member-states-high-level-group-syria, accessed on 11/18/2016.

Liu, Joanne, „Syria: Unacceptable humanitarian failure”, MSF, 11 March, 2015,

http://www.MSF.org/article/syria-unacceptable-humanitarian-failure, accessed on 11/20/2016.

Lynch, Marc, Freelon, Deen and Aday, Sean, ”Syria in the Arab Spring: The integration of
Syria’s conflict with the Arab uprisings, 2011–2013”, Research and Politics, DOI:
10.1177/2053168014549091, 2014.

MSF, ” Millions of people are in desperate need of lifesaving humanitarian aid”,

https://www.msf.org.uk/country/syria, accessed on 18/11/2016.

MSF, ” Syria: Two surgical hospitals bombed in east Aleppo”, MSF, 28 September, 2016,
http://www.msf.org/en/article/syria-two-surgical-hospitals-bombed-east-aleppo, accessed on
11/20/2016 .

MSF, ”Syria Emergency Appeal”, http://www.msf-me.org/syria/, accessed on 11/18/2016.

Rodgers, Lucy, ”Syria: The story of the conflict”, BBC News, March 11, 2016,
http://www.bbc.com/news/world-middle-east-26116868, accessed on 11/18/2016.

Roff, Sherri, ”Nongovernmental organizations. The strengths perspective at work”, International

Social Work, vol. 47, no. 2, 2004.

Stockholm International Peace Research Institute, ” The use of health as a tool of repression in
Syria”, SIPRI, 26 March, 2012, https://www.sipri.org/commentary/blog/mon-03-26-2012-14-
00/use-of-health-as-a-tool-of-repression-syria, accessed on 11/20/2016.

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